Abstract
PURPOSE: The Planetary Health Diet (PHDiet) proposed by the EAT-Lancet Commission is expected to bear health and environmental benefits. This study assesses adherence to the PHDiet in Portuguese adults and its associations with socioeconomic and lifestyle factors. For that, an adapted PHDiet score was computed, and its construct validated. METHODS: Data from the National Food and Physical Activity Survey 2015-2016 were used for this analysis, covering a representative sample of 3852 adults with two non-consecutive dietary interviews (8-15 days apart). Adherence to the PHDiet was measured through a score (ranging from 0 to 140), afterwards divided into terciles (T1-T3). Multinomial regression models were used (i) to assess the construct validity through associations with diet quality based on WHO recommendations and diet environmental impact using greenhouse gas emissions (GHGE) and land use (LU); (ii) to investigate associations between adherence to the PHDiet and socioeconomic and lifestyle characteristics. The prevalence of consumption of PHDiet components above/below the recommendations was estimated. RESULTS: Adherence to the PHDiet was generally low (36.0, 95% CI 35.4-36.6), with high consumption of meat and added sugars and low consumption of pulses, nuts, and whole grains. Higher PHDiet scores were found for diets with lower environmental impact (GHGE: OR(T1vsT3):1.31; 95% CI 1.26; 1.37; LU: OR(T1vsT3):1.25; 95% CI 1.21; 1.29), lower animal protein intake levels (OR(T1vsT3):1.11; 95% CI 1.06; 1.16) and higher diet quality (OR(T1vsT3):0.70; 95% CI 0.68; 0.72), verifying the construct validity. Men (OR(T1vsT3):1.32; 95% CI 1.12; 1.55), intermediate-educated individuals (OR(T1vsT3):1.43; 95% CI 1.16; 1.75), and those facing food insecurity (OR(T1vsT3):1.79; 95% CI 1.36; 2.38) had higher odds of having lower scores. CONCLUSION: Low adherence to the PHDiet is associated with several socioeconomic and lifestyle factors. This highlights the need to implement targeted public health policies that encourage shifts towards a healthier and more sustainable dietary pattern.